Dr. Saud Al-Shlash has a decision to make.
In the air-conditioned triage tent, a stoic 12–year-old lies on his right side on a green canvas cot, a catheter draped to the plastic tarp floor and a large open hole where his left thigh should be—a complication of a bombing wound already one month old. Two burn victims, bandaged like the Invisible Man, lie motionless and groaning nearby, and we're told that more are coming from the same accident in Salman Bak, 30 kilometers (18 mi) outside of Baghdad. Nurses—masked, gowned and gloved—move from cot to cot. A woman with an infected eye places her son's hand on her head and presses it down with all her remaining strength, crying in pain. Already in the operating trailer is a shooting victim. All need immediate attention.
Al-Shlash, chief surgeon and director of the Saudi Field Hospital, paces in the graveled courtyard, talking by radio to a surgeon in the operating trailer, nurses in triage and a pediatrician in a tent at the far corner. There is the sound of gunfire nearby, but he doesn't seem to notice. "Let's do the skin graft," he says at last. A four-year-old is prepped for surgery, his abdomen scrubbed for a graft on a gaping wound on his shin. "His risk of infection is too high," Al-Shlash says. "We'll give him priority."
It's barely eight a.m. This will be the pace of the day, of every day, at this oasis of medical care on the southeast edge of Iraq's traumatized capital city.
People come from Baghdad, Karbala, Najaf, Kut, Mosul, Kirkuk. They are the walking wounded, the immobile on makeshift stretchers and the children—far too many children. They gather at the front gate of the Saudi Field Hospital at daybreak. By opening time at eight, some will have already been waiting for three hours. By day's end, 800 to 1000 of them will receive consultation or treatment.
The hospital staff, including eight surgeons among the 32 doctors and more than 200 medical support staff, were given just three days' notice on April 18, when Saudi monarch King Fahd ibn 'Abd al-'Aziz ordered the deployment of the $80-million humanitarian mission of which they are a part. The mission, coordinated and supplied by the Saudi Red Crescent Society, includes the donation of six fully equipped ambulances, medical evacuation of up to 200 patients to Saudi hospitals and distribution of 400 tons of food and medical supplies. In its first two weeks, the Saudis, working with the Iraqi Red Crescent, distributed 25,000 food packages, each containing staples to feed a typical family for two to three weeks. And more food and medicine are on the way.
But the centerpiece of the mission is the field hospital. There are only three projects of this type currently operating in Iraq. The Jordanian government runs a similar field hospital in Falluja, and the United Arab Emirates is rehabilitating an entire hospital in Baghdad. Most of the Saudi hospital team are drawn from the Riyadh Armed Forces Hospital and are specially trained in field operations. Previous missions have taken them to Somalia, Kosovo and Lebanon and to emergencies within Saudi Arabia.
Traveling into Iraq via Kuwait, accompanied by a security detail of 200 Saudi soldiers and escorted by the American military, the mobile hospital set off on April 21, lumbering north more than 400 kilometers (240 mi) past the wreckage and the fires still burning. "Honestly, we didn't know what to expect," Al-Shlash recalls. "We were coming into the unknown." The convoy of 160 vehicles, including 50 supply trucks and the 15 trailers which make up the sanitized workspaces and overnight wards of the mobile hospital, took two days to reach Baghdad. The doctors camped out in the desert at the halfway point.
Once in Baghdad, the Saudis were on their own. They arrived on the grounds of the new College of Pharmacology in the evening of April 22 and performed their first operation—on a gunshot victim—just six hours after arrival, even before the hospital was fully assembled. Working through the night, the crew got all the critical elements of the hospital positioned in time for the nine o'clock official opening the next morning. In a country where modern communications—telephones, newspapers, television and radio news—have all but ceased to function, word of mouth had already brought a desperate crowd to the front gate.
Desperation is one thing of which there is no shortage in Baghdad. Looting and arson in the city did not spare unprotected hospitals and medical storehouses after the collapse of the Iraqi government. The few hospitals still operating, already crippled by 12 years of shortages, have been unable to restock critical medicines; none now has reliable electricity or running water. Hospital administrations were disrupted and hospital staff, unpaid and exhausted, are sometimes unable to report to work because of the lack of security.
"I haven't seen a worse situation—and I've seen a lot," Al-Shlash says. "It's worse than Somalia here. Iraq is a rich country with a great history. How did it come to this?"
Nationwide, some 16 million Iraqis were dependent on a government-run sanctions-era food-supply system that has now ceased to function. Without electricity or water treatment chemicals, more than one-fifth of the population now has no access to clean water, either. Each of Iraq's humanitarian crises fuels the others, and the result is written on the faces of the patients who stream into the Saudi Field Hospital each day.
Carried on a stretcher by his two sons, 60-year-old Hathod Mgher is brought to the dentist's trailer too weak to even sit up. "It's just a toothache," he whispers. So severe was his pain, his sons say, that he was unable to eat for 10 days. The Saudi dentist quickly concludes that lack of nourishment is now a much more serious problem than the original toothache. Mgher is sent to the air-conditioned outpatient tent for intravenous feeding.
Across the courtyard, a three-year-old undergoes surgery for the removal of a bladder stone much too large for a girl her age. "This is probably the result of malnourishment," Dr. Mohammed Alkerithy, the surgeon, says. Dr. Naser Al-Shehri, one of the hospital's two pediatricians, agrees. "Malnourishment complicates everything," he says. "And we see all nutritional diseases here: vitamin-D deficiencies, marasmus, rickets, iron-deficiency anemia— everything." Even before the war, the United Nations Children's Fund reported that nearly one in four Iraqi children was chronically malnourished.
Dr. Jamal Al-Karbouli, acting director of the Iraqi Red Crescent, thinks we may not yet have seen the worst. "Our people got their last [government-issued] rations two months ago, before the war," he says, "and with no salaries paid in at least two months, of course many of these people were desperate for money to meet their other needs and have sold their food rations. Few people understand the true level of desperation in this country. Who can you explain this to?"
It's a tangled knot that Dr. Al-Shlash hopes the Saudi humanitarian initiative, and others like it, can help begin to untie. "Security is the biggest problem the people face here," he says. "It's a long-term problem and it takes more than soldiers to solve it. How can you expect security in the long term when the people are hungry and sick? This is the foundation."
It's not clear how many months the Saudi Field Hospital will continue to operate. A system of personnel rotations with assignments of one to two months will help to sustain the project. Al-Shehri, the pediatrician, is bone tired at the end of the day. But reclining on the carpeted floor of the break tent, he says he hasn't yet begun thinking of rotating out. "I don't care how long I have to stay, so long as we are helping people," he says.
Photojournalist Thorne Anderson has covered the Balkans, Afghanistan, Palestine and Iraq for numerous international news media, and photographed Arab-world aid to Kosovo for Saudi Aramco World in 1999.